The Reproducibility and Absolute Values of Echocardiographic Measurements of Left Ventricular Size and Function in Children Are Algorithm Dependent

Abstract

Background Several quantification algorithms for measuring left ventricular (LV) size and function are used in clinical and research settings. We investigated the effect of the measurement algorithm and beat averaging on the reproducibility of measurements of the LV and assessed the magnitude of agreement among the algorithms in children with dilated cardiomyopathy (DCM). Methods Echocardiograms were obtained on 169 children from 8 clinical centers. Inter- and intra-reader reproducibility were assessed on measurements of LV volumes using biplane Simpson, modified Simpson (MS), and 5/6 x area x length (5/6AL) algorithms. Percent error (%error) was calculated as the inter- or intra-reader difference / mean x 100. Single beat measurements and the 3-beat average (3BA) were compared. Intra-class correlation coefficients (ICC) were calculated to assess agreement. Results Single beat inter-reader reproducibility was lowest (%error was highest) using biplane Simpson; 5/6AL and MS were similar but significantly better than biplane Simpson (p<.05). Single beat intra-reader reproducibility was highest using 5/6AL (p<.05). 3BA improved reproducibility for almost all measures (p<.05). Reproducibility in both single and 3BA values fell with greater LV dilation and systolic dysfunction (p<.05). ICCs were > 0.95 across measures, although absolute volume and mass values were systematically lower for biplane Simpson compared to MS and to 5/6AL. Conclusions The reproducibility of LV size and function measurements in children with DCM is highest using the 5/6AL algorithm, and can be further improved by using 3BA. However, values derived from different algorithms are not interchangeable.

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy

“…11–13 The %differences reported in the current study are within the same range of prior VVV publications for analyzing the same set of data; however, an important aspect of this study is the demonstration that repeat image acquisition (the realistic clinical scenario) has a significant impact on reproducibility that is often overlooked.…”

“…13 Therefore, the current study used 3-beat averaging and 5/6 area-length method based on these previously published data. This approach is not commonly used clinically and could also improve longitudinal reproducibility.…”

Normative Left Ventricular M-Mode Echocardiographic Values in Preterm Infants up to 2 kg

“…Although 2-dimensional measurements have been recommended in the pediatric population 28 we found that M-mode had practical advantages in these preterm infants. Methods that use 2 dimensional echocardiography such as the area length algorithm 52 are difficult to utilize in agitated preterm infants with risk factors that prevent sedation. MRI imaging would be an ideal validation tool but also has practical challenges in this population.…”

Evaluation of Echocardiographic Measures of Left Ventricular Function in Patients with Duchenne Muscular Dystrophy: Assessment of Reproducibility and Comparison to Cardiac Magnetic Resonance Imaging

“…The inter-observer reproducibility in this study is similar to that found by Margossian et al in a cohort of pediatric cardiomyopathy patients, which also demonstrated the highest reproducibility for 5/6 area-length LVEF. [22]…”

“…Although 3-beat averages improve intra- and inter-observer variability,[22] we chose not to require 2 or 3-beat averages for measurements due to the poor imaging windows in this patient population. Requiring multiple beat averages may have improved our reproducibility, but it also would have significantly decreased the number of measurable studies and would not have accurately reflected the clinical workflow currently employed for these patients in our institution.…”